Healthcare Provider Details

I. General information

NPI: 1982307245
Provider Name (Legal Business Name): KATHERINE G DOUGLAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

221 E CHICAGO AVE SUITE 750
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4080
  • Fax:
Mailing address:
  • Phone: 727-315-7496
  • Fax: 312-227-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number036.180354
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.180354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: